Public health policy expert on meningitis reporting protocols

A public health expert says officials often warn about suspected cases of infectious diseases, balancing patient privacy with the need for health interventions.

Dr. Anna Banerji, from the University of Toronto’s Dalla Lana School of Public Health, was taking questions from CTV Atlantic after concerns were raised about how Dalhousie University and the Nova Scotia Department of Public Health handled an outbreak of meningitis in an on-campus dorm.

The father of an 18-year-old student, Maria Gaynor, says she died of meningitis days after the first case of the disease hospitalized a student who lived on another floor in Shirreff Hall.

Banerji was not involved in the Dalhousie cases and has no specific knowledge of the chain of events, but says health officials generally make public announcements of disease outbreaks to mitigate risk.

“You want to educate people to look for signs and symptoms, and if there’s something you can do about it, an intervention, that’s the main reason you have these things, saying there’s possibly something going on,” she says.

In an interview with CTV Atlantic on Tuesday, Gaynor’s father said his daughter started feeling sick on Sunday, December 11; unaware that Nova Scotia Public Health was investigating a suspected case of meningitis that had hospitalized another student the week before.

Mike Gaynor said that Maria thought she had the flu. But when he didn’t hear from her Monday night or the next day, he worried. He said Maria died in her bedroom and he didn’t find out about the other case of meningitis until he spoke to the medical examiner that Wednesday.

A memo from Dalhousie University’s director of residential life and assistant vice chancellor for student affairs for residence halls dated Monday, December 12, does not mention meningitis or include information on prevention or symptoms.

“Over the weekend, public health notified the university that a case of an infectious disease was identified within our community of residence,” he said.

“Only those contacted by public health are required to take action,” it stated, adding that medical diagnosis of “affected individuals will not be provided” due to privacy.

Dalhousie University continues to refer CTV’s questions about the memo to Public Health Nova Scotia, which has declined CTV’s repeated interview requests.

Instead, NS Health Senior Communications Advisor Krista Keough provided a written statement Tuesday, which read in part:

“Our sincerest thoughts are with the family and friends of those who have been affected by this situation…it is natural to look for reasons why events turned out the way they did and to advocate for any changes to avoid similar tragedies.

“Our initial focus was to identify the immediate contacts of the first case; this takes time and is the most crucial group of people to identify and contact directly.

“We have to balance providing as much information as is necessary at the right time to protect the people at risk, with protecting the privacy and confidentiality of the people involved.

“Certain steps, such as providing counseling and early intervention to high-risk contacts, can be taken based on initial results. Other steps, such as sharing specific diagnoses or offering vaccines, must await more definitive results.”

Last Friday, regional health medical director Dr. Cristin Muecke said results from the CTV lab verifying the meningitis B strain in both Shirreff Hall cases had only returned that day from the National Microbiology Laboratory.

Banerji says officials don’t have to wait for lab results to issue a warning.

“If (a patient) comes in with symptoms of meningitis, even if you haven’t cultured the bacteria or confirmed typing, you might say ‘suspected case’ if it’s clinically consistent with that diagnosis,” Banerji says.

When it comes to patient privacy concerns, Banerji says that depends on the circumstances.

“A big city in Toronto, if you say a 15-year-old boy with symptoms of meningitis ended up in the hospital, that’s one thing,” he says. “Compared to a village in the Arctic where there are only ten 15-year-olds and one of them ends up in the hospital… You have to be careful because you don’t want to give enough information to identify that child.”

Gaynor believes that the students should have been warned of the potentially fatal illness much sooner.

“If something could have been communicated with that word, meningitis, suspected, possible, confirmed, I don’t care, but if that word had been mentioned, we don’t know, but maybe things could have turned out differently, just maybe. ”

Meningitis B is a strain of bacterial meningococcal disease that is spread through direct discharge from the nose or mouth through activities such as kissing or sharing food, drinks, utensils, water bottles, or toothbrushes.

Symptoms of meningitis B can progress rapidly and include worsening fever, headache, stiff neck, sensitivity to light, rash, and changes in alertness. Health professionals recommend seeking immediate medical attention if you develop symptoms.

The Nova Scotia public immunization program for school-age children does not cover the B strain of meningitis. A meningitis B vaccine is available at a cost from doctors and pharmacists and may be covered by some private health programs.

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